Medicare AdvantageReimbursementMedium impact
Medicare annual wellness visit (AWV) reimbursement rate change 2022
UPMC Health Plan·Family Medicine, Internal Medicine, General Practice +1 more·Reimbursement
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
UPMC Health Plan increased reimbursement rates for Medicare annual wellness visits effective January 1, 2022. G0438 now pays $200 and G0439 pays $175, both above Medicare fee schedule rates. Visits must be coded as wellness visits only with appropriate CMS documentation.
Action Required
Immediately: Billing team must update fee schedules in billing system to reflect new UPMC Health Plan rates: G0438 at $200 and G0439 at $175. Ensure annual wellness visits are coded exclusively with these codes (no additional E&M codes). Remind providers that visits must follow CMS parameters with proper clinical documentation as claims are subject to UPMC audit.